Joints of the Lower Limb

Question 1

Osteoarthritis

Answer 1

Degeneration of articular cartilage.

Common in the elderly and former athletes.

Loss of cartilage allows bones to directly articulate with each other which produces pain and decreases function.

Question 2

X-ray findings of osteoarthritis

Answer 2

joint space narrowing and osteophytes

Question 3

Treatment of osteoarthritis

Answer 3

Stepwise from least invasive to most invasive

rest, activity modification, NSAIDs, physical therapy->steroid or hyaluronic acid injection->surgery (arthrodesis or arthroplasty)

Question 4

Hip Joint- Type

Answer 4

Ball and Socket Synovial

Question 5

Hip Joint- Bones involved

Answer 5

Acetabulum of Os Coxa and Head of the Femur

Question 6

Acetabulum- composition

Answer 6

Composed of the fusion of the ilium, ischium, and pubis to make a cup shaped socket socket for the head of the femur

Question 7

Lunate (articular) surface of acetabulum

Answer 7

Deep Surface covered in articular cartilage. as a non-articulating surface in the middle called the acetabular fossa.

Question 8

Acetabular Labrum

Answer 8

Fibrocartilage extension of the rim of the acetabulum.

Question 9

Transverse acetabular ligament

Answer 9

Spans the acetabular notch.

Is continuous with the acetabular labrum.

Question 10

Labrum + Transverse acetabular ligament

Answer 10

Increased depth of the acetabulum and increased contact w/ head of femur.

Question 11

Round Ligament of head of femur

Answer 11

1. Primarily a synovial fold. Also contains a small brach of the obturator artery.
2. Spans the acetabular notch to the fovea capitis
3. NOT a significant contributor to blood supply or stability.

Question 12

Hip Capsule

Answer 12

The reason the hip is so stable.

Question 13

Hip Capsule origins and insertions

Answer 13

Bony rim of the acetabulum and the
transverse acetabular ligament to the intertrochanteric line anteriorly and posteriorly it crosses the femoral neck above to the intertrochanteric crest
Does NOT attach to the neck

Question 14

Bursa for the obturator externus tendon

Answer 14

Lack of attachment of the distal/posterior aspect of the hip capsule allows a protrusion of the synovium

Question 15

Iliofemoral ligament

Answer 15

Anterior/ superior part of hip capsule.
Made of 2 bands-
1. Superior: AIIS and superior brim of acetabulum to greater trochanter
2. Inferior: AIIS and Superior brim of acetabulum to Lesser Trochanter

Question 16

The 3 ligaments of the Hip Capsule

Answer 16

1. Illiofemoral Ligament
2. Pubofemoral Ligament
3. Isciofemoral Ligament

Question 17

Iliofemoral ligament function

Answer 17

Strongest of the hip capsule ligaments
Provides anterior joint support
Helps prevent hyperextension of the thigh
Tightens during hip extension
One reason posterior hip dislocations are more common then anterior.

Question 18

Pubofemoral Ligament

Answer 18

Anterior/inferior part of the hip capsule.

Obturator cost of the superior pubic crest and then blends with Iliofemoral Ligament.

Question 19

Ischiofemoral Ligament

Answer 19

1. Posterior part of hip capsule
2. Ischial acetabular rim to superior femoral neck just medial to base of trochanter.
3. Is weakest and does not provide great coverage- why posterior hip dislocations are more common then anterior.

Question 20

Zona Orbicularis

Answer 20

Deep fibers of the capsule that wind circularly around the femoral neck

Most noticeable in the posterior aspect of the capsule

Question 21

Why is there significantly increased ROM during hip flexion as opposed to hip extension?

Answer 21

The ligaments of the joint capsule pass in a spiral fashion from the pelvis to the femur and tighten, drawing the head of the femur into the acetabulum, during thigh extension

Question 22

Blood supply to the hip capsule

Answer 22

Cruciate Anastamosis
Medical Femoral Circumflex A-
Branch of obturator a via the round ligament of the head of the femur.

Question 23

Major Blood Supply to head and neck of the femur?

Answer 23

medial femoral circumflex a. specifically its retinacular branches

Question 24

Fracture or dislocation of head and neck of femur complications?

Answer 24

• Can cause avascular necrosis if branches of medial circumflex a. is disrupted. Treatment is total hip replacement.
• sciatic nerve injuries

Question 25

Posterior Hip Dislocations

Answer 25

- 90% of all hip dislocations - Most often caused by trauma to a flexed hip (because the capsule is loosened during flexion and the femoral head is not tight within the acetabulum) - affected leg is shortened, adducted, and internally rotated

Question 26

Knee Joint

Answer 26

- Modified Hinge Synovial Joint | - Flexion and extension of the leg with minimal amounts of gliding and rotation

Question 27

Bony Articulations of the knee (3)

Answer 27

-2 femorotibial articulations between the medial and lateral femoral and tibial condyles -1 femoropatellar All lined with articular cartilage

Question 28

Lateral and Medical Menisci

Answer 28

- Sit on top of lateral and medical tibial condyles - composed of fibrocartilage and deepen the articulation - Help prevent dislocation - Act as shock absorber for knee

Question 29

Transverse genicular ligament

Answer 29

Attaches the anterior horns of both menisci to each other and the tibia to help stabilize the menisci by preventing them from being pulled apart during weight bearing

Question 30

The femoropatellar articulation

Answer 30

Gliding joint between the patella and the femur

Question 31

Medial and lateral patellar retinacula

Answer 31

aponeurotic extensions of the vastus medialis and lateralis that extend from either side of the patella to blend with the rest of the capsule

Question 32

Lateral collateral ligament (LCL)

Answer 32

AKA fibular collateral ligament 1. strong, cord-like structure extending from the lateral epicondyle of the femur to the lateral surface of the head of the fibula 2. The tendon of the popliteus muscle travels deep to the LCL separating it from the lateral meniscus 3. Test integrity with varus stress

Question 33

Medial collateral ligament (MCL)

Answer 33

AKA tibial collateral ligament a. Strong, flat, broad ligament extending from the medial epicondyle of the femur to the superomedial surface of the tibia b. At its midpoint, the deep fibers of the MCL directly attach to the medial meniscus. This attachment is the reason medial meniscus tears frequently occur in conjunction with MCL tears c. Test integrity with valgus stress

Question 34

Oblique popliteal ligament

Answer 34

1. A reflection of the semimembranosus tendon over the posterior aspect of the capsule travelling in an inferomedial -> superolateral direction 2. Blends with the posterior aspect of the capsule to strengthen it

Question 35

Arcuate popliteal ligament

Answer 35

Travels in an inferolateral to superomedial direction from the fibular head->arcs over the popliteus tendon->blends with the oblique popliteal ligament and the rest of the posterior aspect of the capsule to provide added strength

Question 36

3 intracapsular knee ligaments

Answer 36

Anterior cruciate ligament (ACL) Posterior cruciate ligament (PCL) Meniscofemoral ligament

Question 37

Anterior cruciate ligament (ACL)

Answer 37

1. Extends from the posteromedial aspect of the lateral femoral condyle to the anterior intercondylar region of the tibia 2. Functions to prevent excess anterior translation of the tibia in relation to the femur or posterior translation of the femur in relation to the tibia depending on which bone is moving 3. Test integrity with the anterior drawer test or Lachman test

Question 38

Posterior cruciate ligament (PCL)

Answer 38

1. Extends from the anterolateral aspect of the medial femoral condyle to the posterior intercondylar region of the tibia 2. Functions to prevent excess posterior translation of the tibia in relation to the femur or anterior translation of the femur in relation to the tibia depending on which bone is moving 3. Test integrity with the posterior drawer test

Question 39

Meniscofemoral ligament

Answer 39

1. Extends from the posterior aspect of the lateral meniscus to the lateral aspect of the medial femoral condyle and may have some fibers that blend with the PCL along the way 2. Functions to stabilize meniscus and contributes to PCL function

Question 40

Meniscofemoral ligament additional names and anatomy

Answer 40

1. If it travels posterior to the PCL, it is called the posterior meniscofemoral ligament (aka ligament of Wrisberg) 2. If it travels anterior to the PCL, it is called the anterior meniscofemoral ligament (aka ligament of Humphrey)

Question 41

sprains

Answer 41

injuries to ligaments

Question 42

strains

Answer 42

injury to tendons

Question 43

Grade 1 Sprain

Answer 43

stretching of ligament with minimal disruption of fibers

Question 44

Grade 2 Sprain

Answer 44

partial tear of ligament

Question 45

Grade 3 Sprain

Answer 45

complete tear of ligament

Question 46

Osgood-Schlatter Disease

Answer 46

repetitive contraction of the quadriceps muscles and chronic small avulsions of the tibial tuberosity by the patellar ligament in young athletes who have recently gone through a growth spurt.

Question 47

Proximal tibiofibular joint

Answer 47

1. Gliding synovial joint between the facet on the fibular head and the facet on the posterolateral aspect of superior tibia with a small capsule surrounding it 2. Slight gliding movements occur here

Question 48

Proximal tibiofibular joint blood supply

Answer 48

The genicular anastomosis

Question 49

Proximal tibiofibular joint innervation

Answer 49

Common Fibular Nerve

Question 50

Distal tibiofibular joint big function

Answer 50

Essential for stability of the ankle joint because it holds the lateral malleolus firmly against the lateral surface of the talus

Question 51

4 ligaments of the distal tibiofibular joint

Answer 51

Interosseous tibiofibular ligament | Anterior and posterior tibiofibular ligaments

Question 52

Interosseous tibiofibular ligament

Answer 52

the major connection between the distal tibia and fibula and is a distal thickened continuation of the tibiofibular interosseous membrane

Question 53

Anterior and posterior tibiofibular ligaments

Answer 53

sit anterior and posterior to the interosseous ligament to help strengthen the joint

Question 54

Transverse tibiofibular ligament

Answer 54

distal continuation of the posterior tibiofibular ligament that spans between the medial and lateral malleoli. This ligament forms the posterior portion of the “mortise” of the ankle joint because it contacts the posterior aspect of the talus

Question 55

Transverse tibiofibular ligament

Answer 55

1. Distal continuation of the posterior tibiofibular ligament that spans between the medial and lateral malleoli. 2. This ligament forms the posterior portion of the “mortise” of the ankle joint because it contacts the posterior aspect of the talus

Question 56

High ankle sprain

Answer 56

1. Does not directly involve the ankle joint. 2. It is a sprain of the distal tibiofibular syndesmosis usually occurring as a result of contact sports (e.g. football) or sports requiring utilization of a rigid boot (e.g. skiing/snowboarding, hockey).

Question 57

Ankle joint

Answer 57

AKA talocrural joint Hinge-type synovial joint between the distal ends of the tibia and fibula and the superior aspect of the talus

Question 58

malleolar mortise

Answer 58

1. . Distal aspects of the tibia and fibula along with the transverse tibiofibular ligament 2. Where the trochlea of the talus sits 3. Strengthened by strong collateral ligaments and a joint capsule that is lined internally by synovial membrane

Question 59

The 3 Lateral ligaments of the ankle

Answer 59

Anterior talofibular ligament Calcaneofibular ligament Posterior talofibular ligament These help to resist against excessive inversion of the ankle but are fragile and are easily sprained.

Question 60

Anterior talofibular ligament

Answer 60

flat, weak ligament that extends from the anteromedial aspect of the lateral malleolus to the neck of the talus ATF- always tears first.

Question 61

Posterior talofibular ligament

Answer 61

thick, strong ligament that extends medially and slightly posteriorly from the distal posteromedial aspect of the fibula to the lateral tubercle of the talus

Question 62

Calcaneofibular ligament

Answer 62

Rounded ligament that extends from the inferior tip of the lateral malleolus to the lateral surface of the calcaneus

Question 63

Medial ligament of the ankle

Answer 63

AKA the deltoid ligament Actually 4 separate ligaments Help to prevent excessive eversion of the ankle

Question 64

The 4 ligaments that make up the Medial / deltoid ligament of the ankle

Answer 64

anterior to posterior 1. anterior tibiotalar ligament, 2. tibionavicular ligament, 3. tibiocalcaneal ligament, 4. posterior tibiotalar ligament

Question 65

Ankle sprain

Answer 65

Most frequently injured major joint in the body. | Almost always results from an inversion injury of a weight-bearing, plantar flexed foot.

Question 66

Ligaments injured in an ankle sprain

Answer 66

The anterior talofibular ligament is the most commonly sprained structure followed by the calcaneofibular ligament.

Question 67

Why does an ankle sprain happen to a plantar flexed foot most commonly?

Answer 67

The shape of the trochlea of the talus and how tight the ligaments of the ankle are stretched. 1. The trochlea is narrower posteriorly causing less surface area articulation with the tibia when the foot is plantar flexed 2. the ligaments of the ankle are more relaxed during plantar flexion leads to less stability

Question 68

Ankle fractures

Answer 68

Caused by excessive eversion or inversion of the ankle

Question 69

bimalleolar fracture

Answer 69

An avulsion fx of the medial malleolus and a fx of the distal fibula. Caused by excessive eversion when the deltoid ligament pulls on the medial malleolus. After the medial malleolus avulses, if the eversion force is strong enough, the talus will slide laterally on the tibia causing stress on the distal fibula causing another break

Question 70

“trimalleolar” fracture

Answer 70

An avulsion fx of the medial malleolus and a fx of the distal fibula AND THE distal tibia. Caused by the tibia shifting forward on the talus, after a bimalleolar fx.

Question 71

Subtalar joint

Answer 71

1. Synovial joint between the talus and calcaneus | 2. inversion and eversion of the posterior foot

Question 72

Talocalcaneonavicular joint

Answer 72

Complex synovial joint between the distal aspects of the talus and calcaneus and the proximal portion of the navicular

Question 73

Ligaments of the subtalar joint

Answer 73

medial, lateral, posterior, and interosseous talocalcaneal ligaments

Question 74

The Spring Ligament

Answer 74

1. The plantar calcaneonavicular ligament. 2. Extends between the sustentaculum tali of the calcaneus and the posteroinferior surface of the navicular 3. Supports the talocalcaneonavicular joint 4. Important with weight transfer from talus during weight-bearing, and helps maintain the longitudinal arch

Question 75

Transverse tarsal joint

Answer 75

Composed of 2 separate joints (talonavicular and calcaneocuboid) that are aligned transversely to allow for increased inversion and eversion of the foot

Question 76

tarsometatarsal joints, and intermetatarsal joints

Answer 76

Relatively small and tightly joined by ligaments so slight movement occurs between them

Question 77

Metatarsophalangeal and interphalangeal joints

Answer 77

Individual synovial joints that mainly allow flexion and extension

Question 78

Long plantar ligament

Answer 78

1. Extends between the plantar surface of the calcaneus to the cuboid and base of the metatarsals 2. Helps maintain longitudinal arch 3. There is a gap in this ligament between its attachment to the cuboid and metatarsals that acts as a tunnel for the fibularis longus tendon as it traverses across the plantar aspect of the foot

Question 79

Short plantar ligament

Answer 79

1. aka plantar calcaneocuboid 2. Extends between the anterior plantar surface of the calcaneus to the plantar surface of the cuboid 3. Helps maintain the longitudinal arch

Question 80

Medial longitudinal arch- Bones involved

Answer 80

``` calcaneus, talus, navicular, 3 cuneiforms, 3 most medial metatarsals ```

Question 81

Medial longitudinal arch

Answer 81

1. Higher than the lateral longitudinal arch with the talar head being the keystone. 2. The talar head is supported by the spring ligament (calcaneonavicular ligament)

Question 82

Medial longitudinal arch- muscles involved

Answer 82

1. tibialis anterior, 2. tibialis posterior 3. fibularis longus, 4. plantar aponeurosis, 5. intrinsic plantar muscles

Question 83

Lateral longitudinal arch- Bones involved

Answer 83

calcaneus, cuboid, 2 lateral metatarsals

Question 84

Lateral longitudinal arch

Answer 84

Flatter than its medial counterpart and rests on the ground during standing

Question 85

Lateral longitudinal arch- ligaments

Answer 85

long and short plantar ligaments

Question 86

Transverse arch - bones involved

Answer 86

cuboid, cuneiforms, bases of the metatarsals

Question 87

Transverse arch - Ligament support:

Answer 87

long/short plantar and spring ligaments

Question 88

Transverse arch - Muscle support

Answer 88

tibialis posterior and fibularis longus

Question 89

Passive stabilization of the boney arches

Answer 89

four layers of fibrous tissue (plantar aponeurosis, long plantar ligament, short plantar ligament, and spring ligament)

Question 90

Dynamic stabilization of the boney arches

Answer 90

from intrinsic and extrinsic muscles of the foot

Question 91

Gout

Answer 91

monosodium urate crystal deposition in joints causing acute inflammation with a possibility of recurrent attacks causing chronic deformities

Question 92

Podagra

Answer 92

Gout of the 1st metatarsal-phalageal joint